Clinical outcomes of first-line antiretroviral therapy in Latin America: analysis from the LATINA retrospective cohort study

Background. Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. Methods. We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. Results. We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio ( aHR = 1.96 ; 95% CI: 1.92-4.00)), rural residence ( aHR = 1.98 ; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms ( aHR = 2.19 ; 95% CI: 1.11-4.37), a fair level of adherence ( aHR = 11.5 ; 95% CI: 2.10-61.10), and a poor level of adherence ( aHR = 12.03 ; 95% CI: 5.4-26.7). Conclusions. In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.

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Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study

The Lancet HIV ◽

10.1016/s2352-3018(20)30358-1 ◽

2021 ◽

Author(s):

Casey L Smiley ◽

Peter F Rebeiro ◽

Carina Cesar ◽

Pablo F Belaunzaran-Zamudio ◽

Brenda Crabtree-Ramirez ◽

...

Keyword(s):

Latin America ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Life Expectancy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The Caribbean

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Clinical outcomes of patients with breast cancer relapsing after (neo)adjuvant trastuzumab and receiving trastuzumab rechallenge or lapatinib-based therapy: a multicentre retrospective cohort study

ESMO Open ◽

10.1136/esmoopen-2020-000719 ◽

2020 ◽

Vol 5 (4) ◽

pp. e000719 ◽

Cited By ~ 1

Author(s):

Eva Blondeaux ◽

Arlindo R Ferreira ◽

Francesca Poggio ◽

Fabio Puglisi ◽

Claudia Bighin ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Brain Metastasis ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

First Line ◽

Her2 Positive ◽

Adjuvant Trastuzumab ◽

Significant Difference

BackgroundIn the prepertuzumab era, we evaluated the clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer who underwent first-line trastuzumab-based or lapatinib-based therapy according to prior exposure to (neo)adjuvant trastuzumab.Materials and methodsIn this multicentre retrospective cohort study conducted in 14 Italian centres of the Gruppo Italiano Mammella, consecutive patients undergoing first-line trastuzumab or lapatinib-based therapy were included. Analyses were performed according to the type of first-line therapy for metastatic disease (trastuzumab or lapatinib). Dichotomous clinical outcomes were analysed using logistic regression and time-to-event outcomes using Cox proportional hazard models controlling for relevant demographic, clinicopathological and therapy characteristics.ResultsOut of 450 patients included in the study, 416 (92%) received trastuzumab and 34 (7.5%) lapatinib. As compared with the trastuzumab cohort, more patients in the lapatinib cohort had a trastuzumab-free interval <1 month (37% vs 13.9%; p=0.017) and brain metastasis as first site of relapse (38.2% vs 9.4%; p<0.001). Among the 128 patients who relapsed after prior (neo)adjuvant trastuzumab, 101 (78.9%) received first-line trastuzumab and 27 (21.1%) first-line lapatinib. The following outcomes were observed with first-line lapatinib or trastuzumab, respectively: overall response rate 45.5% vs 61.3% (p=0.184), clinical benefit rate 68.2% vs 72.5% (p=0.691), median progression-free survival (PFS) 11.4 vs 12.0 months (p=0.814) and median overall survival (OS) 34.7 vs 48.2 months (p=0.722). In patients with brain metastasis as first site of relapse, median PFS was 12.2 vs 9.9 months (p=0.093) and median OS 33.7 vs 28.5 months (p=0.280), respectively.ConclusionsIn patients with HER2-positive breast cancer relapsing after prior (neo)adjuvant trastuzumab, first-line treatment with trastuzumab or lapatinib was not associated with a significant difference in the clinical outcomes. A non-significant trend favouring the use of lapatinib was observed in patients with brain metastasis as the first site of relapse.

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